Urinary Incontinence

Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem that may occur with activity (Stress Urinary Incontinence), the sensation of urgency (the feeling of a sudden need to go to the bathroom: 'overactive bladder'), or both (Mixed Urinary Incontinence). The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time. Some people experience occasional, minor leaks of urine. Others wet their clothes frequently.

If urinary incontinence affects your daily activities, don't hesitate to see your doctor. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence.

Urogynecological Conditions Treated

  • Stress urinary incontinence
  • Urge urinary incontinence (overactive bladder)
  • Difficulty urinating and urinary retention
  • Pelvic organ prolapse: Uterine prolapse, Bladder prolapse, Rectal prolapse

Office Based Services

  • Urodynamic testing
  • Cystoscopy
  • Pessary fittings
  • Pelvic ultrasound

Stress Incontinence Surgery:

  • Suburethral sling with TVT

Tests and diagnosis

It's important to determine the type of urinary incontinence that you have. That information will guide treatment decisions.

After a thorough history and physical exam, we will likely recommend:

Urinalysis. A sample of your urine is checked for signs of infection.

Bladder diary. For several days you record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes.

Post-void residual measurement. Your doctor checks the amount of leftover urine in your bladder after you urinate using a catheter or ultrasound test. A large amount of leftover urine in your bladder may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles.

Special testing

Urodynamic testing. A catheter will be inserted into your urethra and bladder to fill your bladder with water. Meanwhile, a pressure monitor measures and records the pressure within your bladder. This test helps measure your bladder strength and urinary sphincter health, and it's an important tool for distinguishing the type of incontinence you have.

Cystoscopy. Your bladder is checked for abnormalities with a tiny lens and camera.

Pelvic ultrasound. Your urinary tract or genitals are checked for abnormalities.

Treatments include:

Behavioral Modification: Developing ways of managing one's nutrition and fluid intake along with developing effective coping skills.

Pelvic Floor Muscle Exercise (Kegel Exercises): Strengthening the muscles of the pelvic floor

Medications: Anti-cholinergics and adrenergic agonists (designed to relax the bladder) and estrogens (designed to restore a healthy vaginal environment in post-menopausal women).

Pessary use: Devices made of silicon that are placed in the vagina to give support to the opening of the bladder. Pessary fitting is painless and done in the office.

Surgery: For stress incontinence, a 'pubovaginal sling' is usually the procedure of choice. This 15 minute procedure can be performed on an out-patient or overnight basis. It is performed with minimal incisions thus allowing for a speedy recovery and a minimal disruption to a woman's normal activities.